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MENTAL SYMPTOMS ASSOCIATED WITH EXOPHTHALMIC GOITRE.
1811 electrode disconnected without his knowledge with battery His out loudly with the pain. attendant assured me he was absolutely genuine, and thought it was a case of cerebellar disease, though how a blow on the calf could cause this he did not try to explain.
medicalI
working, cried
If the account the last patient and his friends gave is true it is a curious one, as he would appear to have had fits of pure motor aphasia of subcortical type. In these he was unable to speak a word for days and expressed his wants in writing, being able to understand written and spoken speech and to write. Anatomically this would be due to a block of the outgoing ftbres whilst mental speech processes and memory of words is unimpaired, and is a variety which is known to occur in hysteria and an illustration of which is the scriptural one of Zacharias, the father of John the Baptist.4 It is noteworthy that the paralysis was on the correct side, the right, and the patient’s symptoms therefore fitted a hypothetical organic lesion. The view I took of him was that he was a hysterical malingerer. Cardiff. ___________________
MENTAL SYMPTOMS ASSOCIATED WITH EXOPHTHALMIC GOITRE. BY
W.
LEGGETT, B.A., M.D. DUB.,
SENIOR ASSISTANT PHYSICIAN, ROYAL
ASYLUM, MONTROSE.
a conversation. Her manner is rather and commanding, yet she is nervous and tremulous, and becomes more so under observation. Her method of speaking is rather abrupt She always says she feels and somewhat halting. She mistakes the nurses and doctor for well. people she has known at her home and gives them names accordingly. Periodically she jumps impulsively out of bed and takes up a threatening or abusive and sometimes violent attitude towards. On one those who happen to be near to her. occasion she struck a fellow patient for throwing dirt on her, whereas the patient was merely dusting the floor. Certain noises which occur about the room she mistakes for guns which are fired to shoot her. She apparently does not realise where she is at present, nor has she any idea as to the length Her general condiof time she has been with us. tion varies considerably from time to time ; sometimes she is comparatively composed and almost polite, but usually she is excitable, exalted, and rather noisy and difficult to deal with. The most prominent mental features seem to be irritability, impulsiveness, suspiciousness, disorientation, incoherence of speech, exaltation, and a tendency to take up a threatening and abusive attitude. Drugs or other treatment have had na appreciable effect on the condition.
continue
dignified
Montrose.
appears to be of interest on account of the well-marked mental symptoms. The patient is an unmarried female, aged 34 years. Having been certified as insane, she came under my care for treatment. She was described as suffering from hallucinations of hearing and as having the delusional idea that her relations and neighbours were conspiring to poison her food and give her chloroform. It is her first attack, and the mental symptoms are said to have existed for Her father was two weeks before certification. insane and committed suicide. Most of the physical signs usually seen in cases of this kind are present. The thyroid gland is moderately and symmetrically enlarged, a thrill is easily felt by the hand, and a heard by the stethoscope over the murmur gland. No dyspncea or cough is noticeable. The pulsation of the carotid arteries is most remarkable, as is also the apex beat of the heart, for as a result of the latter a wave of pulsation all over the seen may be chest and abdominal walls. The pulse-rate is 142 per minute and tends to become more frequent while the patient is under observation. There is a well-marked fine tremor of the muscles of the face and limbs, and also a staring expression of the eyes. The eyeballs are prominent, but this sign is not well advanced at present. Neither Stellwag’s The pupil nor von Graefe’s sign has developed. seems to be unaffected, but on looking downwards both the upper eyelids enter into a state of spasmodic twitchings. The patient is thin, anaemic, and becomes very breathless on slight exertion. The superficial reflexes are increased. The chief mental features noticed are irritability, restlessness, and a tendency to resent any interference by those about her. She appears to be very preoccupied and often sits or lies in bed with her eyes closed apparently listening to imaginary voices. She rarely makes an attempt to initiate a conversation, but when spoken to she smiles or answers in monosyllables and sometimes incoherently. She does not ask questions or try to THE
following
’
4
_____________
______
case
Purves Stewart: loc. cit.
A CASE OF FIBROSIS OF LUNG TREATED WITH BACILLUS FRIEDLANDER VACCINE. BY ALEXANDER SANDISON, M.B., B.C. CANTAB., B.SC. LOND., TUBERCULOSIS OFFICER TO THE COUNTY BOROUGH OF CROYDON.
THE patient, a married man aged 33, first came under my notice on Nov. 8th, 1913. He gave a. history of having suffered from left-sided pleurisy in 1907 and severe bronchitis in 1910. Except for these illnesses he had enjoyed good general health and was in regular employment as a clerk. In January, 1913, he had a severe cold, with night sweats, and noticed streaks of blood in his sputum. A doctor who attended him diagnosed "phthisis and heart trouble " and ordered a change. Tubercle bacilli were not found in the sputum. He gave up work in consequence and went down to Devonshire, where he gained weight and improved in general health, returning to Croydon in October, shortly before I saw him first, but was nevertheless unable to work on account of dyspnoea and palpitation. My notes on examining him on Nov. 8th were as follows :-
Family history: Negative, except for a sister who died from acute phthisis about 1900, aged 29. Previous diseases :-. None beyond those described above. Symptoms: Cough and sputum moderate, but troublesome ; sputum not foul and never copious. No night sweats nor hæmoptysis. Digestion good and larynx normal. Chief trouble excessive dyspnoea, combined with cardiac palpitation on any exertion. Weight 10 st. 5 lb. Temperature morning 970 F., evening 980 ; pulse 96. Physical signs :-Left lung : Percussion note dull all over front and back. Movement diminished and chest flattened in front. Loud broncho-vesicular breathing with increased vocal resonance. Numerous coarse rates and rhonchi heard all over. Right lung : Impaired note, broncho-vesicular breathing, and coarse rules over the upper two-thirds of the upper lobe in front and behind. Heart : Apex_beat displaced upwards and outwards towards the left axilla, about an inch outside the nipple line. Occasional systolic bruit in the
medicalI
working, cried
If the account the last patient and his friends gave is true it is a curious one, as he would appear to have had fits of pure motor aphasia of subcortical type. In these he was unable to speak a word for days and expressed his wants in writing, being able to understand written and spoken speech and to write. Anatomically this would be due to a block of the outgoing ftbres whilst mental speech processes and memory of words is unimpaired, and is a variety which is known to occur in hysteria and an illustration of which is the scriptural one of Zacharias, the father of John the Baptist.4 It is noteworthy that the paralysis was on the correct side, the right, and the patient’s symptoms therefore fitted a hypothetical organic lesion. The view I took of him was that he was a hysterical malingerer. Cardiff. ___________________
MENTAL SYMPTOMS ASSOCIATED WITH EXOPHTHALMIC GOITRE. BY
W.
LEGGETT, B.A., M.D. DUB.,
SENIOR ASSISTANT PHYSICIAN, ROYAL
ASYLUM, MONTROSE.
a conversation. Her manner is rather and commanding, yet she is nervous and tremulous, and becomes more so under observation. Her method of speaking is rather abrupt She always says she feels and somewhat halting. She mistakes the nurses and doctor for well. people she has known at her home and gives them names accordingly. Periodically she jumps impulsively out of bed and takes up a threatening or abusive and sometimes violent attitude towards. On one those who happen to be near to her. occasion she struck a fellow patient for throwing dirt on her, whereas the patient was merely dusting the floor. Certain noises which occur about the room she mistakes for guns which are fired to shoot her. She apparently does not realise where she is at present, nor has she any idea as to the length Her general condiof time she has been with us. tion varies considerably from time to time ; sometimes she is comparatively composed and almost polite, but usually she is excitable, exalted, and rather noisy and difficult to deal with. The most prominent mental features seem to be irritability, impulsiveness, suspiciousness, disorientation, incoherence of speech, exaltation, and a tendency to take up a threatening and abusive attitude. Drugs or other treatment have had na appreciable effect on the condition.
continue
dignified
Montrose.
appears to be of interest on account of the well-marked mental symptoms. The patient is an unmarried female, aged 34 years. Having been certified as insane, she came under my care for treatment. She was described as suffering from hallucinations of hearing and as having the delusional idea that her relations and neighbours were conspiring to poison her food and give her chloroform. It is her first attack, and the mental symptoms are said to have existed for Her father was two weeks before certification. insane and committed suicide. Most of the physical signs usually seen in cases of this kind are present. The thyroid gland is moderately and symmetrically enlarged, a thrill is easily felt by the hand, and a heard by the stethoscope over the murmur gland. No dyspncea or cough is noticeable. The pulsation of the carotid arteries is most remarkable, as is also the apex beat of the heart, for as a result of the latter a wave of pulsation all over the seen may be chest and abdominal walls. The pulse-rate is 142 per minute and tends to become more frequent while the patient is under observation. There is a well-marked fine tremor of the muscles of the face and limbs, and also a staring expression of the eyes. The eyeballs are prominent, but this sign is not well advanced at present. Neither Stellwag’s The pupil nor von Graefe’s sign has developed. seems to be unaffected, but on looking downwards both the upper eyelids enter into a state of spasmodic twitchings. The patient is thin, anaemic, and becomes very breathless on slight exertion. The superficial reflexes are increased. The chief mental features noticed are irritability, restlessness, and a tendency to resent any interference by those about her. She appears to be very preoccupied and often sits or lies in bed with her eyes closed apparently listening to imaginary voices. She rarely makes an attempt to initiate a conversation, but when spoken to she smiles or answers in monosyllables and sometimes incoherently. She does not ask questions or try to THE
following
’
4
_____________
______
case
Purves Stewart: loc. cit.
A CASE OF FIBROSIS OF LUNG TREATED WITH BACILLUS FRIEDLANDER VACCINE. BY ALEXANDER SANDISON, M.B., B.C. CANTAB., B.SC. LOND., TUBERCULOSIS OFFICER TO THE COUNTY BOROUGH OF CROYDON.
THE patient, a married man aged 33, first came under my notice on Nov. 8th, 1913. He gave a. history of having suffered from left-sided pleurisy in 1907 and severe bronchitis in 1910. Except for these illnesses he had enjoyed good general health and was in regular employment as a clerk. In January, 1913, he had a severe cold, with night sweats, and noticed streaks of blood in his sputum. A doctor who attended him diagnosed "phthisis and heart trouble " and ordered a change. Tubercle bacilli were not found in the sputum. He gave up work in consequence and went down to Devonshire, where he gained weight and improved in general health, returning to Croydon in October, shortly before I saw him first, but was nevertheless unable to work on account of dyspnoea and palpitation. My notes on examining him on Nov. 8th were as follows :-
Family history: Negative, except for a sister who died from acute phthisis about 1900, aged 29. Previous diseases :-. None beyond those described above. Symptoms: Cough and sputum moderate, but troublesome ; sputum not foul and never copious. No night sweats nor hæmoptysis. Digestion good and larynx normal. Chief trouble excessive dyspnoea, combined with cardiac palpitation on any exertion. Weight 10 st. 5 lb. Temperature morning 970 F., evening 980 ; pulse 96. Physical signs :-Left lung : Percussion note dull all over front and back. Movement diminished and chest flattened in front. Loud broncho-vesicular breathing with increased vocal resonance. Numerous coarse rates and rhonchi heard all over. Right lung : Impaired note, broncho-vesicular breathing, and coarse rules over the upper two-thirds of the upper lobe in front and behind. Heart : Apex_beat displaced upwards and outwards towards the left axilla, about an inch outside the nipple line. Occasional systolic bruit in the